Putting more muscle into the physiotherapy department

Modern physiotherapy units have space and functionality, which serve patients and staff alike. This room is located in the Anschutz Outpatient Pavilion of the University of Colorado Hospital in Denver, Colorado.

If you were learning to walk again after a stroke, would you want an audience? Of course not. But given the space restraints at the four adult physiotherapy departments of the McGill University Health Centre (MUHC) sites, you might not have a choice.

A total of 225 outpatients are seen daily at the Montreal Chest Institute (MCI), the Montreal General Hospital (MGH), the Montreal Neurological Hospital (MNH), and the Royal Victoria Hospital (RVH). Only one site has a waiting room, so most physiotherapy patients wait in hallways for their treatments, often in areas of heavy traffic. Sometimes that is even where the therapy takes place. "Patients, for example," explains Antoinette Di Re, MUHC (RVH/MCI/MNH) Physiotherapy Manager, "are taught to walk in the hallways and both the out- and inpatient clientele are treated in the same area of the department. Which means athletes may be in the same room as patients with severe neurological deficits. That may be motivating for some, but it is inappropriate for most. And confidentiality in such an environment is problematic."

Even once inside, the existing treatment spaces are insufficient at an average of only 50 square feet, making it difficult to fit patients, staff, equipment and furniture. The size of these areas will hopefully increase by 20 per cent on the new site.

Finally, there are no cloakrooms or lockers for patients to leave their valuables. The Physiotherapy Department on the Glen site, on the other hand, will allow for considerable improvements. Plans include adding satellite rehabilitation units on the medical, geriatric, neurological, surgical, plastics and orthopedic wards in the new site that are wheelchair accessible, so patients won't have to wait to be transported to a central physiotherapy room as they are now. Other improvements for patients:

different gyms for the different diagnostic groups (i.e.: musculo-skeletal, cardio-pulmonary, and neurological) ensuring a more appropriate patient mix;

enough changing rooms; and

a centralized reception and booking centre that will help eliminate confusion for patients who now arrive at the wrong hospital.

There are other ways that patient comfort and safety can be built into the physiotherapy space. One hospital—Colorado's Anschutz Center for Advanced Medicine, seen on a site visit—used a soft floor material in the middle of the main physiotherapy area while keeping the outer track lane firmer and more resilient for patients practicing their walking movements.

Staff will also benefit by:

clear room partitions to offer better sight lines to patients;

computers at every necessary workstation;

proper storage facilities; and

places for staff to store personal items.

"The department on the new site will also bring improvements to the work environment of staff who currently do not have desks or places to work," explains Sophie Burnett, MUHC MGH Physiotherapy Manager. "For many, the pockets of their lab coats and their binders serve as their offices as these hold evaluation tools, appointment books and patient lists. The new plans include work stations for the physiotherapists, a conference room, a patient education and resource centre and some shared space, such as conference or teaching rooms and gyms, with other professional groups, which will facilitate multidisciplinary teamwork. These gains mean greater efficiency, quality in patient care, teaching and research."

Although the pediatric physiotherapy area is now and will continue to remain apart from the adult population, it, too, is looking forward to space that is better organized on the new site. "We are looking for a brighter, better ventilated spot where we can group our wide variety of patients more effectively," explains Eileen Kennedy, Professional Coordinator of Physiotherapy at the Montreal Children's Hospital. "Right now, the windows are up at ceiling height so the children cannot even look outside during their treatments. As well, we have babies and elite young athletes sharing the same gym. Yes, we look forward to the move."